Maguire Daniel G, Ruddock Mark W, Milanak Melissa E, Moore Tara, Cobice Diego, Armour Cherie
Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, Northern Ireland.
Randox Laboratories Ltd, Clinical Studies, Crumlin, County Antrim BT29 4QY, Northern Ireland.
Nat Sci Sleep. 2020 Jul 31;12:545-562. doi: 10.2147/NSS.S260734. eCollection 2020.
Sleep disturbances (SD) are the most impactful and commonly reported symptoms in post-traumatic stress disorder (PTSD). Yet, they are often resistant to primary PTSD therapies. Research has identified two distinct SDs highly prevalent in PTSD; insomnia and nightmares. Those who report SDs prior to a traumatic event are at greater risk for developing PTSD; highlighting that sleep potentially plays a role in PTSD's pathology. To further understand the pathobiological mechanisms that lead to the development of PTSD, it is first imperative to understand the interplay which exists between sleep and PTSD on a biological level. The aim of this systematic review is to determine if biological or physiological markers are related to SD in PTSD.
A systematic literature search was conducted on the electronic databases; Medline, Embase, AMED and PsycINFO, using Medical Subject Headings and associated keywords.
Sixteen studies were included in the final analyses. Physiological makers of autonomic function, and biochemical markers of HPA-axis activity; inflammatory processes; and trophic factor regulation were related to the severity of SDs in PTSD.
These findings add to the growing literature base supporting a central focus on sleep in research aiming to define the pathophysiological processes which result in PTSD, as well as emphasising the importance of specifically targeting sleep as part of a successful PTSD intervention strategy. Resolving SDs will not only reduce PTSD symptom severity and improve quality of life but will also reduce all-cause mortality, hospital admissions and lifetime healthcare costs for those with PTSD. Limitations of the current literature are discussed, and key recommendations future research must adhere to are made within.
睡眠障碍（SD）是创伤后应激障碍（PTSD）中影响最大且最常报告的症状。然而，它们通常对PTSD的主要治疗方法具有抗性。研究已确定在PTSD中高度普遍存在两种不同的睡眠障碍；失眠和噩梦。那些在创伤事件之前报告有睡眠障碍的人患PTSD的风险更大；这突出表明睡眠可能在PTSD的病理过程中起作用。为了进一步了解导致PTSD发生的病理生物学机制，首先必须了解睡眠与PTSD在生物学层面上存在的相互作用。本系统评价的目的是确定生物学或生理标志物是否与PTSD中的睡眠障碍相关。
使用医学主题词和相关关键词在电子数据库；Medline、Embase、AMED和PsycINFO上进行了系统的文献检索。
最终分析纳入了16项研究。自主神经功能的生理指标以及HPA轴活动、炎症过程和营养因子调节的生化指标与PTSD中睡眠障碍的严重程度相关。
这些发现增加了越来越多的文献基础，支持在旨在确定导致PTSD的病理生理过程的研究中重点关注睡眠，同时强调将睡眠作为成功的PTSD干预策略的一部分进行专门靶向治疗的重要性。解决睡眠障碍不仅会降低PTSD症状的严重程度并改善生活质量，还会降低PTSD患者的全因死亡率、住院率和终身医疗费用。讨论了当前文献的局限性，并提出了未来研究必须遵循的关键建议。
